Article
Surgery of adrenal tumors in children
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Published: | May 20, 2011 |
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Introduction: Adrenal tumors are one of the potentially fatal causes of childhood hypertension. Because the clinical presentation of adrenal tumors is variable and aspecific, it is often discovered incidentally. Adrenal tumors requiring operative intervention have been traditionally approached via various open approaches. However, these lesions are well suited to a laparoscopic approach because they are usually small and situated deep in the retroperitoneum. The aim of this study was summarized the results of adrenal surgery in single centre during 20-years period.
Materials and methods: During this period 39 children with different adrenal tumors were treated. There were 13 children with Cushing’s syndrome, 9 – with pheochromocytoma, by threes with virilizing and mixed tumors, 2 – with esteromas, one – with Conn syndrome, 4 patients had non-functioning tumors, and adrenocortical cancers was in 3 patients.
Results: Adrenalectomy was performed in 37 (84.9%) patients. Two (5.1%) children with corticochromoblastoma and chromoandroblastoma did not operated due to the disseminated metastasis at the time of admission. Conventional lumbotomy was applied in 30 (81.8%) patients and in 7 (18.2%) – laparoscopic adrenalectomy. Laparoscopic adrenalectomy was performed in 3 children with pheochromocytoma, in 3 – with adrenal cyst and in 1 – with myelolipoma. The indication of laparoscopic surgery was a well-encapsulated tumor with no evidence of tumor invasion into surrounding tissues or lymphadenopathy. Mean duration of open adrenalectomy was 105.0±11.0 min with the mean blood loss – 169.8±37.2 mL. Mean duration of laparoscopic adrenalectomy was 90.5±4.0 min with significantly lower blood loss (74.3±8.9 mL). All patients who underwent adrenalectomy were discharged with normal blood pressure.
Conclusion: Thus, the laparoscopic adrenalectomy suitable for the children with adrenal tumors independently of functional status of tumor but in cases of preoperative confirmed malignant character of adrenal pathology the open adrenalectomy is more preferable.